1. 3
Therapeutic
Communications

2. Standard
Assessment

3. Competency
Integrate scene and patient assessment findings with knowledge of epidemiology and pathophysiology to form a field impression.
This includes developing a list of differential diagnoses through clinical reasoning to modify the assessment and formulate a treatment plan.

4. Introduction
As a paramedic, you must use every strategy to make sure you understand your patients and they understand you.
Word choice, tone of voice, facial expressions, body language.
Adjust your communication style to fit each new situation.

5. Introduction
Sincere desire to be part of helping profession; understanding of human strengths and weaknesses; empathy.
Communication: sender, message, receiver, feedback.
Sender: encodes, creates message.
Receiver: decodes, interprets message.
Feedback: response to message.
Class Activities
Give a student a brief message, and have the student encode it and send it to another student.
Create a barrier for decoding and feedback (different language, wrong feedback, etc.)

6. Introduction Failure to Communicate
Prejudice, or lack of empathy.
Lack of privacy.
External distractions.
Internal distractions.
Patience and flexibility hallmarks of good communicator.

7. Building Trust and Rapport
When trust established, rapport follows.
Establish positive rapport quickly.
Ask patients the right questions.
Respond with empathy.
With good rapport, people you are serving will follow your lead.
Effective communication begins and ends with trust and rapport.
Discussion Topics
With the students, discuss each way you can build trust, and how not building a rapport can impede patient care.

8. Building Trust and Rapport
Present yourself as caring, compassionate, competent, confident health care professional.
Dress and grooming important.
Voice, body language, gestures, eye contact communicate you care about patient's problems.
Be aware of your patient's comfort.

9. Building Trust and Rapport
If patient in obvious distress, try to alleviate his pain or discomfort while you interview him.
Introduce yourself.
Use patient's name.
Modulate your voice.

10. Building Trust and Rapport
Use professional but compassionate tone of voice.
Explain what you are doing, and why.
Keep a kind, calm facial expression.
Use the appropriate style of communication.
Class Activities
Have several students interview each other as medic/patient. Make each patient have a scary, gory, life-threatening injury/illness. Have the paramedic talk to the patient with various facial expressions (angry, scared, etc). Discuss with the students how the patient will look at your facial expression for comfort and confirmation.

11. Introduce yourself and use an appropriate compassionate touch to show your concern and support.

12. Effective Communication Techniques
General Guidelines
Patients' response to questioning:
Pour out information easily.
Reveal some things; conceal others.
Resist, hiding information.
Be consistently professional, nonjudgmental, willing to talk about any concern.

13. Effective Communication Techniques
Nonverbal Communication
Gestures, mannerisms, postures person uses to communicate with others.
Distance: socially acceptable distance between strangers is 4 to 12 feet.
Relative level: remaining at eye level indicates equality.

14. Interpersonal Zones

15. Effective Communication Techniques
Nonverbal Communication
Dropping below eye level helpful when patient elderly adult or child.
Open stance: arms extended, open hands, relaxed large muscles, nodding head.
Closed stance: arms flexed, or arms crossed tightly over chest.
Class Activities
Have students interview each other using various degrees of distance, eye contact, and stance. Discuss results.

16. Getting down to a patient's level can help improve communications on a pediatric call.

17. Effective Communication Techniques
Nonverbal Communication
While interviewing patient, use eye contact as much as possible.
Look at patient frequently.
Eye contact one way to send message to patient.
Nothing builds trust and rapport, or calms patients, faster than the power of touch.

18. Effective Interviewing Techniques
Identify patient's chief complaint, learn circumstances that caused emergency, determine patient's condition.
Ask questions, observe patient, listen effectively, use appropriate language.
Gather information that is accurate, complete, relevant to emergency.
Points to Emphasize
Explain to students the importance of using effective interviewing techniques and how it helps them to do their jobs more efficiently.

19. Effective Interviewing Techniques
Let patient state chief complaint in his own words.
Chief complaint should drive all other questions to be asked.
Continue to ask open-ended questions.
Use direct questions when necessary.
Do not ask leading questions.

20. Effective Interviewing Techniques
Ask only one question at a time; allow patient to complete his answers.
Listen to patient's complete response before asking next question.
Use language patient can understand.
Do not allow interruptions, if possible.

21. Effective Interviewing Techniques
Active Listening
Listen closely to what patients tell you.
Do not develop tunnel vision from dispatch information.
Begin assessment without any preconceived notions.
Watch for subtle clues patient may not be telling truth.

22. Effective Interviewing Techniques
Listening is an active skill, not a passive one.
Requires your complete attention.
Focus on the messenger.
Watch for clues to important signs, symptoms, emotions.
Modify questions to follow clues.
Provide feedback to confirm you have understood message correctly.

23. Effective Interviewing Techniques
Feedback Techniques
Silence
Reflection
Facilitation
Empathy
Clarification
Confrontation

24. Effective Interviewing Techniques
Feedback Techniques (cont'd)
Interpretation
Asking about feelings
Explanation
Summarization

25. Effective Interviewing Techniques
Common Errors
Providing false assurances.
Giving advice.
Abusing authority.
Using avoidance language.
Distancing.
Using professional jargon.
Talking too much; interrupting.
Using “why” questions.
Discussion Topics
Talk with students about how they can avoid some of the traps of interviewing.
Discuss techniques that they have used that have worked and those that have not.

26. Effective Interviewing Techniques
Observing Your Patient
Observe patient during interview.
Note appearance, level of consciousness, body movements.
Be aware of defense mechanisms.
If indication patient's hostile behavior may threaten your safety or crew, maintain distance and exit path.

27. Effective Interviewing Techniques
Using Appropriate Language
Most patients will not understand medical terms.
Use appropriate level of questions; do not appear condescending.
Barriers to communication: cultural and language differences, deafness, speech impediments, blindness.

28. Special Needs and Challenges
Start interview in usual manner.
Develop rapport by reviewing reason dispatch gave for call.
Attempt to ask open-ended questions.
If unsuccessful, try direct questions.
Class Activities
As in the other class activities regarding communication, have students role play communication scenarios involving special challenges and needs. Allowing actual dialog will enforce proper communication techniques for the students.

29. Special Needs and Challenges
Provide positive feedback.
Be sure the patient understands questions.
Rule out language barriers, hearing difficulties, pathology.
Class Activities
As in the other class activities regarding communication, have students role play communication scenarios involving special challenges and needs. Allowing actual dialog will enforce proper communication techniques for the students.

30. Special Needs and Challenges
Children
Effective communication with pediatric patients depends on their age.

31. Childhood Development by Age

32. Childhood Development by Age

33. Special Needs and Challenges
Children
Start by talking to caregivers.
Gradually approach patient.
Get down to child's eye level.

34. Special Needs and Challenges
Children
Introduce yourself; use child's name often; be careful not to clam up.
Tell child everything: what you are looking at and why it is important.
Most important, you must build trust.
Giving child stuffed toy may be helpful.
Use straightforward language.

35. Special Needs and Challenges
Children
More matter-of-fact and informative you can be, the better.
Use lots of eye contact; compassionate touch.
Ask child for feedback frequently.
Be aware young children very literal; word choice important.
Build trust and rapport with parents.

36. Use a small toy to help calm a child.

37. Special Needs and Challenges
Elderly Patients
Be respectful; use formal means of address.
Speak slowly and clearly.
Interviews might take longer.
Use compassionate touch.
Give elderly patient choices whenever possible.
Take along their “living assists.”

38. Special Needs and Challenges
Patients with Sensory Impairment
Blind present special problems.
Identify yourself immediately.
Nonverbal communications useless in these cases.
Voice and touch only effective tools.
Ask hearing-impaired and deaf patients preferred method of communication: lip reading, signing, writing.

39. Special Needs and Challenges
Angry, Hostile, Uncooperative Patients
Understand anger is a natural part of grieving process; may be venting their frustration.
Try to accept their feelings without getting defensive or angry in return.
Be nonthreatening; avoid confrontation.

40. Special Needs and Challenges
Angry, Hostile, Uncooperative Patients
Set limits and establish boundaries.
Document unusual situations.
If blatantly hostile, or your safety is jeopardized, stay far enough away.
Monitor patient closely.
Be sure you have clear path to exit.
Do not hesitate to call law enforcement.

41. Special Needs and Challenges
Sensitive Topics
Sexual activities, death and dying, physical deformities, bodily functions, domestic violence.
Make the unfamiliar familiar; it will seem less imposing.
To earn patient's trust, try to make him or her feel problem is not uncommon.

42. Special Needs and Challenges
Sensitive Topics
Sexual history taken later during history; it can be part of present illness or past history, depending on chief complaint.
Remain calm, objective, nonjudgmental, regardless of how patient answers.

43. Special Needs and Challenges
Silence
If patient suddenly becomes silent, try to determine why, what is happening, what you should do about it.
Stay calm; observe patient's nonverbal clues.

44. Special Needs and Challenges
Overly Talkative Patients
Accept less comprehensive history.
Briefly give patient free rein.
Focus on important areas.
Ask closed-ended questions.
Interrupt frequently; summarize what he says.
Try not to become impatient.

45. Special Needs and Challenges
Patients with Multiple Symptoms
Challenge is to discover chief complaint.
Sort through multitude of information quickly; recognize patterns that lead to correct field diagnosis.
Anxious Patients
Anxiety natural reaction to stress.
Encourage patient to speak freely about the signs of anxiety.

46. Special Needs and Challenges
Patients Needing Reassurance
Do not be overly reassuring or prematurely reassure anxious patient.
Intoxicated Patients
Irrational, disrupt your control of scene, rarely allow you to examine them.
Make sure your environment safe.
Avoid challenging body language or remarks.

47. Special Needs and Challenges
Crying Patients
Crying form of venting; clue to patient's emotions.
Accept it as natural release; do not try to suppress it.
Depressed Patients
Depression potentially lethal; recognize its signs and evaluate its severity.
Ask about suicide risk.

48. Special Needs and Challenges
Confusing Behaviors or Histories
You may encounter patient whose story you just cannot follow.
In these cases, problem cannot be diagnosed in field.
If patient's behavior seems distant, aloof, inappropriate, or even bizarre, suspect mental illness.

49. Special Needs and Challenges
Confusing Behaviors or Histories
Delirium and dementia disorders relating to cognitive function.
Delirium common in acutely ill or intoxicated patient.
Dementia occurs frequently in elderly.
Often cannot provide clear, accurate histories.

50. Special Needs and Challenges
Patients with Limited Intelligence
Do not assume patient will not be able to provide accurate information concerning medical status.
Try to evaluate patient's education and mental abilities.
If you suspect severe mental retardation, obtain history from family or friends.

51. Special Needs and Challenges
Talking with Families or Friends
Patients who cannot give useful information: find third party who can.
Patient confidentiality priority.

52. Transferring Patient Care
When you arrive at scene, EMS-trained first responders may already be there.
Before they transfer patient care to you, listen to their report carefully.
Integrate information they give you into questions you ask patient.
Interact with emergency colleagues with respect and dignity.
Discussion Topics
Discuss with the students what can happen to a patient when critical information is not transferred, such as allergies, complaints, and so on.

53. Summary Quickly and effectively gather information about patient.
Remember your body language, tone of voice, facial expressions, how you position yourself to patient.
Develop situational communication templates that you can draw on as scenarios unfold.

54. Summary
Situations that require assertiveness or calm, empathetic compassion call for two different communication styles.
You will need sensitivity to recognize and respond to signs of suffering to create ideal, individualized process of communication.
Show compassion and empathy; demonstrate expertise necessary.